Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis

Kempen, Diederik H.R.; Heemskerk, Johan L.; Kaçmaz, Gozde; Altena, Mark; Reesink, Herre J.; Vanhommerig, Joost W.; Willigenburg, Nienke W.

doi:10.1016/j.spinee.2021.12.011

Cited by 14 publications

(8 citation statements)

References 133 publications

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“…Our team believes that a high Cobb angle is strongly associated with high rates of postoperative complications in children, and that these patients tend to have more complicated preoperative comorbidities and require more complicated corrective surgery compared with those with low Cobb angles. An inverse relationship between Cobb angle and patient lung function was shown in a metaanalysis by Diederik [17]. Cobb angle progression was signi cantly associated with patient lung dysfunction in that study.…”

Section: Discussionmentioning

confidence: 53%

Prediction of delayed extubation and admission to intensive care units in children undergoing scoliosis posterior fusion surgery: a retrospective observational study

Wang

Xia

et al. 2023

Preprint

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Background: Delayed postoperative extubation and admission to intensive care units (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay and increase medical costs. However, after scoliosis orthopaedic surgery, whether a child will require delayed extubation or ICU admission is not fully understood. This study reviewed the risk factors for delayed extubation and ICU admission after scoliosis orthopaedic surgery in children.Method: We reviewed and analysed the electronic medical records of paediatric patients (≤ 18 years) undergoing posterior spinal fusion surgery from January 2018 to November 2021. The patients’ characteristics (age, sex, body mass index, American Society of Anesthesiologists grade, preoperative lung function, combined heart disease), preoperative Cobb angle, scoliosis type, orthopaedic rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allotransfusion, intraoperative haemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg), surgical time, postoperative extubation and admission to the ICU were collected. The main outcomes were delayed postoperative extubation and postoperative admission to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and admission to the ICU.Results: We enrolled 246 children who met the inclusion criteria, of which 23 (9.3%) had delayed extubation and 81 (32.9%) were transferred to the ICU after surgery. High American Society of Anesthesiologists grade (odds ratio (OR) = 5.42; 95% confidence interval (CI): 1.49–19.78; P = 0.010), high Cobb angle (OR = 1.04; 95% CI: 1.02–1.07; P < 0.001), moderate to severe pulmonary dysfunction (OR = 10.9; 95% CI: 2.00–59.08; P = 0.006) and prolonged surgical time (OR = 1.01; 95% CI: 1.00–1.03; P = 0.040) were risk factors for delayed postoperative extubation. High Cobb angle (OR = 1.02; 95% CI: 1.01–1.04; P = 0.004), high intraoperative bleeding volume (OR = 1.06; 95% CI: 1.03–1.10; P = 0.001), allogeneic transfusion (OR = 3.30; 95% CI: 1.24–8.83; P = 0.017) and neuromuscular scoliosis (OR = 5.38; 95% CI: 1.59–18.25; P = 0.007) were risk factors for postoperative transfer to the ICU. High Cobb angle was a risk factor for both delayed postoperative extubation and admission to the ICU. Age, sex, body mass index, number of vertebral fusion segments, orthopaedic rate and intraoperative tidal volume were not associated with delayed postoperative extubation and admission to the ICU.Conclusions: The most common risk factor for delayed postoperative extubation and ICU admission in paediatric patients who underwent posterior spinal fusion was a high Cobb angle. Our results demonstrated that determining poor prognostic risk factors may help optimise perioperative management strategies for children undergoing complicated spinal surgery.

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Section: Discussionmentioning

confidence: 53%

Prediction of delayed extubation and admission to intensive care units in children undergoing scoliosis posterior fusion surgery: a retrospective observational study

Wang

Xia

et al. 2023

Preprint

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“…These changes, to some extent, correlated with the angle of the spine curvature [ 17 ]. According to a meta-analysis review by Kempen et al, there is an inverse relationship between Cobb’s angle of curvature and lung function [ 18 ]. In our own research, no relationship was observed between the value of spine curvature and the initial value of maximum pressure during exhalation (r = 0; p = 1) and the initial value of maximum pressure during inspiration (r = 0.007; p = 0.976).…”

Section: Discussionmentioning

confidence: 99%

The Influence of Surgical Correction of Idiopathic Scoliosis on the Function of Respiratory Muscles

Jasiewicz

Rożek

Kurzeja

et al. 2022

JCM

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Background and objective: It is important to introduce respiratory exercises to the therapy of patients after the surgical treatment of adolescent idiopathic scoliosis. Surgical correction is the best way to prevent hypoxia in scoliosis, but whether pulmonary rehabilitation increases the effectiveness of scoliosis surgery has not yet been confirmed. Therefore, the aim of the study was to evaluate the function of respiratory muscles after surgical correction of idiopathic scoliosis. Methods: The study involved 24 patients, aged 13.6 ± 0.6. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using the Mikro RPM. In all patients, before the procedure, 7 days after and 3 months after the procedure, the MIP and MEP were measured. Results: MIP was the lowest 7 days after the procedure; it was 45.28 cmH2O and was statistically significantly lower compared to the measurement before the procedure (p < 0.001) and 3 months after the procedure (p < 0.001). Conclusions: The degree of curvature of the spine before the procedure does not significantly affect initial values of the strength of respiratory muscles. The level of MIP is not dependent on the type of surgery.

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“…Although a recent systematic review with meta-regression analysis revealed that the pulmonary function in patients with idiopathic scoliosis was inversely related to the curve severity [18], this review was limited by the summary of associations between coronal Cobb angles and various pulmonary parameters among patients of different types of idiopathic scoliosis. Because AIS is a three-dimensional spinal deformity, examining these associations based on coronal Cobb angles alone is incomprehensive [19].…”

Section: Introductionmentioning

confidence: 99%

Is impaired lung function related to spinal deformities in patients with adolescent idiopathic scoliosis? A systematic review and meta-analysis—SOSORT 2019 award paper

et al. 2022

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Purpose Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. Methods A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. Results Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = − 0.245), %FVC (r = − 0.302), FEV1 (r = − 0.232), %FEV1 (r = − 0.348), FEV1/FVC ratio (r = − 0.166), TLC (r = − 0.302), %TLC (r = − 0.183), and percent predicted vital capacity (r = − 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = − 0.215) and %TLC (r = − 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05). Conclusion Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.

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Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis

Cited by 14 publications

References 133 publications

Prediction of delayed extubation and admission to intensive care units in children undergoing scoliosis posterior fusion surgery: a retrospective observational study

Prediction of delayed extubation and admission to intensive care units in children undergoing scoliosis posterior fusion surgery: a retrospective observational study

The Influence of Surgical Correction of Idiopathic Scoliosis on the Function of Respiratory Muscles

Is impaired lung function related to spinal deformities in patients with adolescent idiopathic scoliosis? A systematic review and meta-analysis—SOSORT 2019 award paper

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